Spastic Diplegia from Interferon Alpha-2a

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Spastic Diplegia from Interferon Alpha-2a

Hemangiomas in infants can destroy tissue, obstruct a vital structure, or, in a small minority, threaten life. For endangering hemangiomas that fail to respond to first-line therapy with high-dose corticosteroids, interferon alpha-2a (IFN) has been advocated. IFN is associated with a variety of adverse effects, most of which are transient or reversible. This report documents a serious, possibly irreversible adverse reaction in infants treated with IFN for endangering or life-threatening hemangiomas.

A group of 26 infants who had been treated comparably with IFN were followed with careful neurologic examinations and MRIs. Five of these infants developed diplegia. Doses ranged from 1.02 to 3.60 million units per day (with cumulative doses of 279.66 to 1,946.04 million units). The earliest signs were most easily identified when the infant was relaxed and held suspended from the axillae. Abnormal posture consisted of hip adduction and extended knees. Scissoring developed with more advanced diplegia. After discontinuation of IFN, diplegia persisted for one to three years in three infants, while the other two gradually recovered over several months. Initial MRIs of two infants with diplegia (one transient, one persistent) showed delayed myelination, a finding not seen on repeat MRIs.

Comment: IFN has been associated with several central nervous system side effects, including diffuse encephalopathy, seizures, psychoses, and paresthesias. Spastic diplegia was reported previously in a two-year-old child with laryngeal papillomatosis who received a seven-month course of interferon alpha-n3 at two to three million units per day. The cause of this effect is unknown and not thought to be dose dependent. Preservatives in the commercially available injectable solutions, such as phenol or benzyl alcohol, are suspected culprits. Use of the powder form suspended in preservative-free saline would obviate this concern. For infants who are candidates for IFN therapy, the risk of spastic diplegia must be weighed carefully against the potential benefits of this therapy.

— EC Siegfried

Published in Journal Watch Dermatology May 1, 1998

Citation(s):

Barlow CF et al. Spastic diplegia as a complication of interferon Alfa-2a treatment of hemangiomas of infancy. J Pediatr 1998 132 527-530.

Medline abstract (Free)

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